Commentary on political happenings around the nation and locally in Milwaukee, WI.

Wednesday, February 28, 2007

Health Care Reform, Slowly but Surely

In one of the more eye-rolling legislative press releases I've seen in awhile, Senate Minority Leader Scott Fitzgerald (R-Juneau) swiped at Senate Democrats for not already proposing comprehensive health care reform in the current legislative session.

“The State Senate has now been in session for four days in regular session," Fitzgerald explained.

That's right. Four whole days.

Senate Majority Leader Judy Robson properly shot back her own press release that easily dismissed the minority leader's rhetoric. As Robson explained, the Dems are choosing to take their time getting feedback from the public before moving forward on any single plan.

And if the state GOP's experience with TABOR is any indication, proceeding slowly but surely is a wise move. Rather than creating a three ring circus situation like the one that existed last spring -- where conservative Republicans fell over each other proposing new amendments that would appeal to moderate Republicans only to alienate other conservative Republicans in the process -- any significant reform measure needs to make sure the horse is before the cart from the beginning.

On Monday, for instance, the Marshfield News Herald did a story on a forum held by the Stevens Point League of Women Voters that featured speakers on each of the three health care reform proposals made during previous legislative sessions (the proposals that Fitzgerald and Republicans, then in control of the entire legislature, opted to do nothing about).

As David Riemer -- spokesperson for the Wisconsin Health Plan (WHP) -- pointed out at the event, none of the plans is likely to move through the legislature in its current form. Ultimately, a hybrid proposal is most likely to be put forward.

In light of a recent UPI/Zogby poll on health care reform, this is probably the best route to go. While 9 out of 10 Americans want health care reform, the disagreement is in the details. But the poll did show that a majority believed any reform measure needs to be a combination of public and private solutions.

If the Wisconsin public feels the same as the rest of the country, it suggests that Riemer's WHP is best positioned out of the three existing proposals to appeal to the broadest range of citizens. While the WHP is a combination of public and private solutions through its continuation of private insurance and use of HSAs within a publicly accountable centralized structure, the Wisconsin Health Care Partnership Plan leans more heavily on government regulation and the Wisconsin Health Security Act does so exclusively.

Whichever plan is ultimately pursued by legislative Democrats in the state, it's clear proceeding cautiously is smart. The sheer scope of any significant reform measure is complicated by the fact this is a budget year, and the mix becomes outright volatile when considering all of the ways to spin and attack any proposal that fundamentally alters the way an expensive and complex system is funded.

There's inevitably going to be winners and losers with an undertaking as large as fundamental health care reform. And rather than simply consider whether more winners will exist in the proposed system or whether the extent of losing in the new system is less than the losing that's already taking place in the existing system, the debate can quickly focus on the fact that there will be losers at all.

Therein lies the catch-22 of actually passing fundamental health care reform: There can't be any losing in a reform measure that can't help but create winners and losers. Changing the terms of how reform measures are evaluated is the monumental task, and it's one that takes securing the broadest level of public awareness and support possible before even stepping into the ring.

5 Comments:

Anonymous said...

Wow - now that was a good spin job. After years of the Dems railing on Reps to do something about health care, you would think that the dems would be further along in the process. Does a party have to be in a legislative majority to work on a solution?

If the Reps did nothing, but started their plan on health care today, the same as the Dems are doing, you would screaming from high heaven that they have shown no results. If the Dems had more than political/election rhetoric to offer, we would have seen at least one plan ready to go. You certainly do not need the majority to introduce a bill. Other than the ridiculous "bill to have a bill" the Dems have introduced nothing substantive over the last few sessions.

By starting the process now - they are freely admitting that up until now they had nothing. And until they have a plan ready to actually be presented - they still have nothing.

So what is the timeline for their proposal? At what point must those so skilled at pointing out other's supposed shortcomings actually produce a workable plan?

As we have heard for years - the people are demanding action! There are children without health care! Peopla are suffering!

The problem with health care is, unlike other consumer services, the customer does drive the price. Free market competitive forces are almost non existant. The ONLY way health care costs can be controlled is put the consumer in charge and give him or her the incentive to "shop" for price and value.Without consumers forcing providers to compete for their business we are left with bureaucrats setting prices and rationing care when funds are tight. That's what Canada does and that's England does. They ration health care to control costs. Americans are not going to like rationing, guaranteed.A government controlled monopoly is the socialistic approach and it will not work the way Americans envision it will work.A consumer driven health care system is the capitalistic approach and while it will not be perfect it will be far better than putting the government in control of health care.

Other than the ridiculous "bill to have a bill" the Dems have introduced nothing substantive over the last few sessions.

Are we talking about the same legislature, Anon? The Dems proposed three health care plans during the last legislative session. The WHP, to take one of the three, has been in the works for going on three years now. Here's the history of the plan's development. It's got plenty of substance.

Health care reform isn't just any bill. We're talking about fundamentally reforming one of the biggest industries in the state, which is going to have a significant impact on everyone in Wisconsin. This needs to be done right, not only because there's a lot to loose if it isn't, but also because it doesn't stand a chance at going anywhere unless it's as air-tight as possible.

The last time the Dems tried to push fundamental reform without having all of their ducks in a row first was 1994, and that failure scared politicians away from proposing anything meaningful on health care again for a decade. Just in the couple years has it started to become politically feasible to talk about fundamental health care reform on a widespread basis.

If Dems in Wisconsin move too quickly and overplay their hand -- like the GOP did with TABOR the past two sessions or Bush did with privatizing social security a couple of years ago -- it's going to set the realization of health care reform back even further. And the fact that this is a budget year doesn't make things any less complicated between now and late summer.

If this legislative session comes to an end without the Dems proposing fundamental health care reform, I'll most certainly go after them for it. But, for goodness sakes, we're just 4 regular sessions into the legislative year. Plus, no reform proposal is going to get put into place until the next budget comes out in 2009, anyway. Bottom line, there's plenty of legislating left to go. If you want to call that spin, that's fine. It doesn't make it any less true.

Russ,

Have you even looked into the WHP? Do you even know what it entails? Here's info on the plan. Tell me one place where you see anything about a "government controlled monopoly."

On the issue of rationing, it happens in the US all the time already. To provide a couple of examples, here and here show instances of outright health care rationing in the US. The LA Times has also produced a number of stories lately on California underwriting policies that exclude entire job sectors from coverage because they're too risky. And the JS just ran a similar story the other day about how middle aged people are getting priced out of health coverage due to underwriting policies here in Wisconsin.

As health policy expert Matthew Holt explains: "So yup [rationing] happens here too, and instead of doing it by some defensible way — like looking at the cost-benefit analysis for a population — that an economist ought to commend, we do it on the basis of whether or not you can afford it."

To make rationing a required and significant facet of any health plan that involves government regulation is nothing more than unsubstantiated conservative rhetoric. While rationing may happen in Canada and England, it doesn't happen in France, Germany, Japan, Switzerland, Holland, and a number of other countries with single payer insurance.

Plus, the fact is health outcomes and satisfaction rates are higher in those countries than here in the US, in spite of the fact that they spend half as much on their health care per capita.

But I'm actually not set on single payer coverage as the only way to go. I think it would be the best for the country, but I'm very willing to accept a plan like the WHP, which, if you check it out, you'll find is based on consumer-driven free market principles.

As I said when we had this exact same discussion before, Russ, I'm just interested in what reform works -- I could care less how it gets done ideologically. You need to ask yourself, do you feel the same? Is this about solving the health care crisis for you, or is it about defending a pre-determined ideology?

We best get smart, and soon. The public is already paying for 100% of our healthcare - through co-pays, deductibles, bankruptcy costs, and more importantly when employers add their health costs to their product prices and we reimburse them at the cash register.

For the same amount of money we are spending today to cover 85% of the population, 15% of GDP, we could have a single-payer system that covers 100% of the people -- without Canada's wait times and rationing -- and we'd be a better country for it.

Any doubts? Put it to a vote and see what the majority of the public wants!

Should the federal government guarantee health insurance for all Americans?* Yes -- 64 percent* No -- 27 percent

Which would you pick if you had to choose between maintaining the Bush tax cuts and making sure all Americans have access to health care?* Access to health care -- 76 percent* Maintain tax cuts -- 18 percent

What would be better, single payer health insurance or our current health insurance system?* Single payer -- 47 percent* Current system -- 38 percent

While a larger percentage back single payer than the current system, it's clear many who want reform -- even fundamental reform -- don't want single payer, as much as it pains me to say it. Maybe educating the public could help with that, but it seems to me that's a long term goal. A better goal for the short term is to aim at statewide reforms that take important steps toward centralizing our health care system in order to get a better handle on cost while simultaneously offering universal access to a standard of coverage that prevents cases of under-insurance (unless the person wants it). The WHP happens to be a great model for this important first step.